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VPT1-0008-EN | A | Case Presentation: What Your Knots Are Doing To The Rotator Cuff

Neal ElAttrache

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Case Presentation: What Your Knots Are Doing To The Rotator Cuff

I'm actually going to show a brief case of demonstration to what suture material, especially the very strong non-absorbable suture material, can do inside the shoulder to both the cuff. And also, I've seen significant abrasive changes on the articular cartilage in the glenohumeral joint. So this is a 19 year old female left hand dominant. And. That top line is wrong. She's a right hand dominant hitter college volleyball player. And she had presented with a two year history of posterior left lateral shoulder pain following arthroscopic labral repair that she had performed. She was unable to return to to college volleyball without pain, despite aggressive rehabilitation, and she complained of posterior lateral shoulder pain and a dead arm when swinging. She had had the surgery performed prior to her presentation to me in May of 2008. She had had a superior labor repair in a vasectomy, and the rotator cuff was noted to be, quote, normal with no articular sided abrasion or tear. On her physical examination, when I saw her, she had generalized hyper laxity, as we see with a lot of these volleyball players. She had apprehension. She had a positive relocation sign. O'brien's test was positive in all of her impingement signs were positive. She had negative sub scap signs and no pain with crossover. Further exam showed the Paris Scapular dyskinesias with mild winging. So she had a sort of a protective scapular dyskinesias that she was using to keep her out of pain. She had good strength of her rotator cuff. Mild tenderness to palpation over the bicipital groove. Mri scan findings showed some supraspinatus tendinosis with partial articular sided cuff tearing. She had cystic formation at the anterior margin of the distal supraspinatus. Mild separation of the anterior-superior labrum and a patulous capsule. You can see here the cystic change in the anterior aspect of the greater tuberosity, just behind the biceps. So I took her to the O.R. in July of 2010. And we're going to see the what we found. We saw the labral repair itself had healed, but there was this not that then with with in the in the overhead hitting position or would be in the throwing position that not has abraded braided and cut a hole in the side of the rotator cuff. So, you know, even before this case, I'd become very concerned with what these knots can do in that particular kind of patient. When they get up here, the rotator cuff is going to drape itself over the posterior superior glenoid rim and labrum. And so not material is not as as benign as what we might think. And while a lot of times it does get covered over with synovial tissue or scar tissue in the back there, sometimes the these knots are very prominent. And with constant abutment and abrasion, you'll rub off that biologic layer that forms. And these these braided nylon knots are sitting right there. And do abrade the, the rotator cuff. So this is not the first time I've seen this. And it certainly causes symptoms in a lot of cases. So I took that knot out. We repaired the anterior-superior labrum because the part in front of the bicep was off, and that's why she was getting apprehension. So she actually felt the shoulders slide a bit and the anterior-superior labrum had had to be repaired. I took that posterosuperior not out at six months. She's got good range of motion nine months. She returned to volleyball at the end of her college eligibility. So she was able to salvage that last year of college. But but it's loss of time in somebody like this is can be a devastating problem for these college athletes. And your high school athletes have a certain amount of time to get back. So something is benign as as not problems on the undersurface of the cuff can cost them a season which which for them is very meaningful. I'll refer to this again in my my next talk on superior labor repairs, where I show a knotless technique for repair. Thank you.

Case Presentation: What Your Knots Are Doing To The Rotator Cuff

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